Measuring the success of global health programs and medical relief efforts is multi-faceted and complex to say the least. However, FOTCOH boasts several features, which have certainly contributed to the success of the organization in providing medical care here in Haiti.

First and foremost is trust. It is easy to see that patients here believe in, and appreciate the work being done on their behalf. Although it is sad to see the group of people who camp out for days waiting their turn, it is a testament to the trust the locals have in this organization.

Secondly is the continuity of care the patients receive. Whether it’s a diabetic, hypertensive adult, or a malnourished child, they can rest assured their treatment plan will be scrutinized every two months, and monitored for success. The team is as vigilant with their chronic patients as any clinic in the United States.

Third is the organization of the group. Although there are many first timers, the team functions at a high and efficient level, seeing a tremendous amount of patients in a short amount of time. The teamwork is incredible, allowing both acutely ill and chronically unstable patients to be seen in a timely manner.

Finally, is the sense of family you feel when working with this organization. Some of the volunteers have been working with FOTCOH for years, developing not only friendships among themselves, but with the Haitian staff, and the patients. For those of us who are here for the first time, we are welcomed and made to feel right at home.

Like any healthy family, it is continuing to grow and face daily challenges that are real and palpable. However, the commitment to the FOTCOH family by all those involved assures me those challenges will be met for years to come.

-Michael, MDMay 2013

*

In the first years after construction on the clinic was complete, Dick sent patients in need of surgery to the far north of Haiti, to a hospital called Hôpital Sacré Coeur, located in Milot. Hôpital Sacré Coeur had a rotating schedule of volunteer doctors who traveled to Haiti to perform surgeries, and Dick was always pleased with how they took care of patients. The hospital was clean and the staff was professional. Whenever Dick made arrangements for a patient to make the journey, he would give them money for food and lodging, and a Haitian staff member would accompany them to Milot to make sure they arrived safely. Milot was far away—the trip from Jacmel took almost two full days, so a stop in Port-au-Prince to stay overnight was necessary.

Dick wanted to be able to help surgery patients at a facility much closer to the clinic. It always made him nervous to send patients such a long distance, even though he knew Hôpital Sacré Coeur was a good facility. But since the medical volunteers weren’t responsible for the surgery, Dick wasn’t able to follow up with the patients to make sure they were being monitored once they returned from the hospital, and that made him uncomfortable. He wished there was a better way to take care of patients closer to home, and closer to their own families.

Dick found the solution through a volunteer named Garron Lukas. A surgeon from the United States, Garron had a private surgical practice in Champaign, Illinois, for many years. A quiet man, Garron always speaks slowly and calmly, never raising his voice. He is quick with a joke, although always serious in his delivery. Originally from Detroit, Michigan, Garron attended medical school in Florida. Following graduation, he completed his surgical training in San Francisco and then joined the army, where he was assigned to the elite special operations unit known as Delta Force, working mostly on hostage rescue missions. After seven years in the military, Garron left to start his private practice and teach at the University of Illinois.

Garron first visited Haiti in 2003. At the time his wife, Sharon, was a nurse recruiter for a hospital in Champaign, where she met Kay, one of clinic’s volunteers. Kay was leading one of the medical teams to Haiti in a few short weeks and she was worried that she might have to cancel the trip entirely—she didn’t have a doctor signed up, and without one, according to the clinic’s medical guidelines, the team could not treat patients, and all the planning would be for nothing. Sharon mentioned to Kay that her husband was a doctor and said she would ask him if he would be interested in volunteering.

Fortunately for the medical team, Garron had been looking for an opportunity to get involved with an organization just like FOTCOH, and, even though it was short notice, he was willing to go to Haiti. Not only did Garron go with Kay’s team, but Sharon joined him as well. Garron enjoyed his first volunteer experience at the clinic, and he continued to volunteer, sometimes returning multiple times in a year. He got to know Dick and Barb well while in Haiti, and over time he became familiar with the specifics of the clinic’s medical program.

After a few years of treating patients at the clinic, Garron discussed with Dick the notion of performing surgery on the property. He had seen a good number of patients who were in need of surgery, and since some of the surgeries were minor, he knew he would be able to perform them himself instead of sending the patients all the way to Milot. Dick agreed it was a good idea, and he gave Garron the go ahead to do surgeries on site. And, just like the surgery the team had performed on the woman in the cornfield in the early days of the medical missions, Garron performed his surgeries outside, taking advantage of the natural light, on an exam table set up under a tree in the shade, away from the other patients.

After performing a number of successful, simple surgeries, however, Garron knew he wanted to do more for his patients. To do that, he would need to work in an appropriate facility—one that could offer post-surgery care and allow him to take on more serious cases. He was seeing patients with tumors and hernias, and he just wasn’t able to do that type of surgery at the clinic. Garron and Dick weighed their options and decided they would look into adding a proper surgery program to the clinic operations.

A few months later, Garron and Dick set out to visit hospitals in Haiti to see how other surgery programs worked—what equipment was being used and what kind of surgeries were being performed. Although an experienced surgeon, Garron didn’t know what it would take to meet the requirements for surgery in Haiti—getting an idea of how other hospitals operated was crucial. They visited hospitals and clinics throughout northern Haiti, including rural hospitals. They visited facilities run by both Haitians and foreigners. Although some of the places they saw had decent equipment and sanitation practices, Garron found the standards fairly low—crude, even, compared to the United States. He was confident that he would not only be able to achieve basic standards of care in Haiti, but most likely exceed those standards.

After returning from their travels, Dick and Garron set out to find a location in Jacmel that would be adequate for a surgery program and postoperative monitoring. The first place they visited was St. Michel Hospital, the largest hospital in the Sud-Est department and the one closest to the clinic. Garron found the conditions to be unacceptable. The hospital consisted of multiple dilapidated buildings spread out over a massive piece of land, each building indecipherable from the next and none appearing particularly safe for a patient to enter. Outside the main building, where new patients checked in, a stack of old desks and chairs were piled almost two stories high, crowding the entryway. In the waiting room, dusty old hospital beds and broken office furniture shared the room with patients and their family members. Nothing was clean. The operating room had open windows. The staff was reusing surgical gloves. Garron didn’t feel that any safe surgery was taking place there.

After leaving St. Michel, they visited the Dr. Martinez Hospital, located in the heart of Jacmel. A small, private hospital, the Dr. Martinez Hospital was run by Dr. Robert Martinez, a Haitian doctor specializing in obstetrics and gynecology. Dick knew Dr. Martinez—he had volunteered with the early medical missions before the clinic was built, and Dick liked working with him, finding him professional and kind. Dr. Martinez also spoke Creole and some English, which had allowed him to converse freely with the patients and the medical volunteers.

The Dr. Martinez Hospital was close to the clinic as well, and, since St. Michel Hospital was off their list, it became the next best option—just as long as it was up to par. When they arrived, Garron could tell immediately the hospital was in much better condition than St. Michel. The hospital was painted bright blue and pale green, and vibrant, green shrubs surrounded the small parking lot. When Garron and Dick went inside, they found the surgical room on the first floor, and patient rooms on both the first and second floors. The hospital also had a delivery room. All the rooms were sterile, and tidy. The hospital had a small laboratory and a pharmacy, both of which were orderly and sanitary. Garron and Dick were both satisfied with how clean and well maintained the whole hospital was—compared to St. Michel, the difference was night and day.

During their visit, Dick and Garron also got a chance to meet with Dr. Martinez and explain their intentions. Dr. Martinez was hopeful about the possibilities of working with Garron. He could offer the space to perform surgery, as well as allow them to keep surgical equipment safely at the hospital. In exchange, FOTCOH would pay a fee per patient to use the facility.

Dick and Garron felt assured that working with Dr. Martinez was the right move. As they headed back to the clinic, they were confident in having taken the first step towards creating the surgery program, yet realistic about how much needed to be done. It would still be a long time before Garron would be ready to perform surgery, even with the space within the hospital secured. He needed proper surgical equipment and a sterilizer, as well as an anesthesia machine. Purchasing these items, all of which were expensive, and getting them into the country would not be a simple task. In all, it would take Garron nearly two years to get the equipment he needed into Haiti to get the surgery program started.

*

Dr. Martinez introduced Garron to Dr. Frantzso Nelson in 2006. When the pair met, Nelson was in his early thirties and had been working with Dr. Martinez for two years. He was a soft-spoken man, known for his kindness and patience. Always seen with a big grin on his face, he never seemed stressed, or fatigued, even though his job at the hospital was demanding.

Nelson was from Jacmel, but he attended medical school in the Dominican Republic. Medical schools are more plentiful in the Dominican Republic than in Haiti—the Haitian government only accepts about one hundred students a year into medical schools in the country, making the application process very competitive. After finishing medical school, Nelson returned to Jacmel to find a job working with a local doctor so he could acquire experience—there was no residency program in Haiti, so it was up to him to get the training he needed to practice medicine on his own. In 2004, he began working with Dr. Martinez. He learned a lot under Dr. Martinez’s stewardship and, after a few years, he started his own practice within the hospital, which he still has today. He also runs a free clinic in a slum area of Jacmel.

When Dr. Martinez introduced Garron and Nelson, he suggested that Nelson would make a good assistant once the new surgery program got started. Nelson liked the idea—he knew he could learn a lot from an experienced surgeon like Garron. And Garron agreed that it would be helpful to have someone who lived in Jacmel to work alongside him. That way, he wouldn’t have to worry about surgery patients after he left Haiti. If any complications arose when Garron was gone, Nelson would already be at the hospital. To this day, one of Nelson’s most important roles in his work with the surgery program is overseeing the post-surgical care of Garron’s patients.

Nelson was also able to help Garron in other significant ways. From the beginning, Garron knew he needed an anesthesiologist, someone who was qualified and able to work for a few weeks at a time at the hospital throughout the year. He didn’t know many Haitian medical professionals, especially in specialized fields, and without one, the surgery program could not function. Luckily, Nelson knew someone—an anesthesiologist named Dr. Blasey, who lived in Port-au-Prince. At Nelson’s persuasion, Dr. Blasey agreed to travel to Jacmel whenever Garron was performing surgery. Without Nelson’s recommendation, the surgery program might have not gotten off the ground. Over the years, Nelson continued to be an outstanding resource whenever the situation required a specialist, and Garron was endlessly grateful for everything he was able to do to help with the surgery program’s success.

Back at home, Garron worked to get surgical supplies collected. Some surgical instruments were donated by the hospital where he had his practice in Illinois, and he was able to secure a grant through a charitable foundation to purchase other items he needed. He also received donations of electrosurgical units and autoclaves from US manufacturers of the instruments. With each trip that Garron made to Haiti to volunteer at the clinic, he would bring surgical equipment with him piece by piece, until he had adequate equipment in place to start the program.

With his team in order, the hospital secured, and the surgery equipment purchased and brought into Jacmel, Garron was finally ready to start performing surgery at the Dr. Martinez Hospital. After years of preparing, he couldn’t be more pleased with how the program was turning out, especially with the help of Nelson and Dr. Blasey. When the surgery program officially began in 2007, Garron felt that it was better than most he had seen in Haiti.

*

Nelson not only worked closely with Garron, but was also able to offer the team something invaluable—insight into the lives of Haitians. As the only Haitian doctor that has worked at the clinic on a consistent basis, Nelson continuously helped the volunteers understand how Haitians think about health care, and how their beliefs structure those feelings. Nelson explained that, many times, the way Haitians think about their health is deeply influenced by their practice of Vodou. And although roughly eighty percent of Haitians consider themselves Catholic, and twenty percent consider themselves Protestant, as Barb will contest, all Haitians believe in Vodou.

Vodou originated in the 1700s, when African slaves who were brought to Haiti developed their own religion. After being forcefully Christianized upon arriving in the country, slaves who did not want to give up their own religious beliefs and traditions combined aspects of African religious traditions and Catholicism to create Vodou. Those who practice Vodou offer prayers to spirits who are thought to provide protection, healing, and good health. Prayer offerings usually involve various ceremonies and rituals, often with a component of music and dance.

Because of his knowledge of Vodou and Haitian culture, Nelson was especially helpful to the volunteers whenever a patient seemed unresponsive during examinations. Many times, he explained, if a person goes to a Vodou priest to be healed of a health issue, the priest will tell a person what is ailing them without asking any questions about their symptoms. Because of this, Haitians sometimes believe that American doctors should know what is wrong without answering any questions or without being examined. This trust in Vodou traditions can make it difficult for foreign doctors to treat their Haitian patients properly.

According to Nelson, many Haitians don’t always want to trust Vodou in every part of their lives, but sometimes they have no other resources for receiving help. When they can’t afford to see a doctor, they go to a Vodou priest. Like so many people in the world, they want to believe in something that offers them hope in their day-to-day lives, and trusting in Vodou when their health is at risk is sometimes all they have. But, as Nelson would argue, just as Haitians might believe in Catholicism and Vodou at the same time, they also believe in Western medicine and Vodou practices simultaneously.

Nelson also says that since he has worked for the clinic, he has seen Haitians change the way they think about their health. He has seen many Haitians returning to the clinic because they are feeling better. They believe the medications they are receiving are working. He knows they are also talking to their family and friends about the care they are receiving and encouraging them to see a doctor as well. He feels, without a doubt, that the Haitians trust the medical teams, and they trust the clinic.

*

Some of the things Garron has seen while performing surgery are not surprising to him, considering his career, but some things even he could not have anticipated. He had never before had to consider what he would do if a piece of surgical equipment broke, because in the United States it could be fixed. But in Haiti, it wasn’t guaranteed that there would be someone who knew how to fix specialized equipment, which meant if something broke, surgery could be held up for an unforeseeable amount of time.

Garron also had to consider whether he would have access to clean water, or whether or not electricity would be available in the hospital, something he normally never would have given a second thought. Initially, he used the city power at the hospital, but electrical surges took a toll on the equipment. It became necessary to start using a generator for all the surgery cases. One day, while Garron was performing surgery on a man who had a large hernia, the room went black. The man’s intestines had been sitting out on his abdominal wall at the time. Now, as Nelson hurried out of the operating room to find out what happened, Garron waited in the dark, holding the man’s intestines. Nelson came back and told Garron the generator had run out of gas, and he had to go out to get more. Half an hour went by before Nelson returned and filled the generator. The lights came back on, and they continued with the surgery.

But even though there have been unforeseen circumstances along the way, the surgeries Garron has performed have been incredibly successful. Garron is proud of the record of the surgery program at the Dr. Martinez Hospital, and he is especially proud of Nelson’s progress over the years. Although he had little surgical experience at first, Nelson has learned a lot working alongside Garron. When they began working together, Nelson called Garron at home three or four times a month to ask questions. Gradually, those calls became less frequent, as Nelson became more comfortable with his capability to take care of patients when Garron was away. They have accomplished a great deal in their work, and have been through so much. They have grown close, and for that reason, Nelson feels like a son to Garron.

Today, the FOTCOH surgery team has performed close to 1,200 surgeries with no deaths and no major complications. Garron Lukas is the only surgeon who has ever worked with FOTCOH.

*

The FOTCOH Child Sponsorship Program was born accidentally. It started when Dick met a young Haitian girl named Natasha.

When Dick first met her, Natasha was eight years old. Before the clinic was built, when the medical team was still working at the Sea of Love, a group of Haitian children were playing soccer one evening to entertain the volunteers. Dick noticed that one little girl in particular was a fantastic soccer player. She was fast, and had total control of the ball. But as Dick watched her, enthralled by her talent, he noticed that she wasn’t moving quite right—she had a brace on her foot, which made it difficult for her to walk, let alone run.

Natasha had a clubfoot. A birth defect, a clubfoot causes the bones in the feet to turn inwards. Because of this deformity, a person will either walk on their ankles or the sides of their feet. Dick was so impressed by Natasha’s skills, despite the challenge her foot created, that he wanted to do something to correct her clubfoot. He spoke with her parents, and they agreed to let Dick help. Within a few weeks, he found an organization in Port-au-Prince that could perform the surgery, and he scheduled an appointment.

Natasha responded well to the surgery. Shortly after the procedure and some physical therapy, she was able to walk without difficultly, and she no longer needed a brace on her foot. Other than a few scars, no one would have guessed she ever had a problem. After Natasha returned to Jacmel, Dick figured he couldn’t see having her foot corrected and then not making sure she went to school. In Haiti, no child gets an education for free. It costs money to attend school, and uniforms and school supplies are an additional expense. Many families do not send their children to school because they can’t afford the tuition.

Dick and Barb decided to sponsor Natasha, making sure she had money for school fees. Over the next few years, they started sponsoring a few other children that they met along the way. Once the clinic construction was complete, the interest in sponsorship really began to grow. The medical volunteers wanted to know how they could help the young patients they were treating, knowing their families had no money for school for their children.

Since Barb was now retired and in Haiti most of the year, she decided to make the sponsorship program official. She started by writing down information about the children who visited the clinic—she recorded their names, their birthdays, and the towns they lived in. She then took photos of the children and created a packet to give out to FOTCOH supporters back home. The response was huge. Hundreds of people agreed to sponsor children, and before she knew it, Barb had her hands full.

After the sponsorship program took off, Barb got some of the non-medical volunteers involved in keeping the children in the program organized. She even created a special Sponsorship Week for the volunteers to come to Haiti, separate from the medical team, just to work on updating child profiles and take new pictures for the sponsors back home. When the volunteers were not in Haiti, Boyer made sure the families received the funds and that the children’s reports cards were periodically turned in so sponsors knew the children were attending school.

At its peak, nearly 380 Haitian children were enrolled in the program, most of whom Barb could name just by seeing them at the clinic.

*

Dick met Gerald when he was around ten years old, back when the clinic was still under construction. Thin and small for his age, Gerald carried tools for Boss Ken. He followed Boss Ken around, lugging hammers and buckets of nails. Gerald did whatever Boss Ken asked of him, and he worked hard, trying to learn the trade. He was a smart and sweet kid—Dick never saw him look unhappy on the job site.

Dick saw Gerald working with Boss Ken almost every day, and he would chat with him here and there. One morning, Gerald showed Dick some drawings he had made of construction plans, and Dick was blown away—here was such a young boy with all these big ideas. He asked Gerald why he wasn’t in school. He said he didn’t go to school because he had to work. Dick asked him if he was getting paid to help Boss Ken, and Gerald said no—he was an apprentice.

Dick stopped the conversation and went to look for Boss Ken. When he found him, he asked him why Gerald wasn’t in school. Boss Ken said the boy wanted to learn, so he was teaching him. Dick was not satisfied with the answer—he felt Gerald needed to get an education. Boss Ken argued that Gerald did not make enough money to pay for school. Dick shot back, stating he understood that Gerald didn’t make any money at all.

Dick insisted that starting the next day, Gerald was going to school. He could work with Boss Ken in the morning, or after school, but he was going to go to school every day. From then on, Gerald went to school, and Dick and Barb made sure he had money to attend. As he got older, Gerald had many other sponsors who supported him through the sponsorship program. After finishing primary and secondary school, Gerald went on to a university in Port-au-Prince to study civil engineering.

*

When Dick met Milo, he looked like a fish, his skin resembling white scales as the result of an unknown skin disease. No doctor in Jacmel could determine the cause, so Milo had never been treated. He was a small boy, only about eight years old, and his condition caused his skin to be constantly irritated. Because of the way it made Milo look, it also made him an outcast.

Milo was in absolute misery. He wanted to die.

Milo’s father brought him to the clinic to see if the medical team could do anything for his son. The doctors determined that Milo’s case was so rare that they would not be able to care for him. Wanting desperately to help Milo, Dick made arrangements for him to see a specialist. He found an American dermatologist in Port-au-Prince that would see Milo as soon as he and his father could get there. Dick sent them to the city, with money for transportation, food, and lodging. Thankfully, the doctor was able to find the cause of Milo’s skin problem. He was prescribed special ointments and instructed on how to care for his skin.

When Milo came back to Jacmel with his father, Barb enrolled him in the sponsorship program. Again, Dick and Barb didn’t want to just get Milo treated without making sure he could go to school. And, thanks to many sponsors over the years, Milo went through primary school, secondary school, and then on to medical school in the Dominican Republic.

Though the FOTCOH Child Sponsorship Program grew quite large, after more than fifteen years of sponsoring children in Haiti, the program was canceled. As Barb started to get older, it had become much harder for her to handle all the responsibility, and no other volunteers were in Haiti often enough to take over for her. Although Boyer had always been very helpful, the program was taking away from his responsibilities managing the clinic, and, though it was hard to do, it simply became time to end it. Even though the program ended, Dick and Barb were grateful for what they had been able to do with the help of many sponsors for such a long time. And more so, they were incredibly proud of all the Haitian children they had the privilege of watching grow up.

*

Dick and Barb had been through many storms and hurricanes in Haiti. At times, fallen trees and scattered debris had caused considerable damage to the clinic property. But nothing compared to the 2010 earthquake, not only in its destruction, but in the response it received in regards to emergency relief. The earthquake left some parts of Haiti in complete shambles as hundreds of thousands of buildings collapsed. Because so many buildings were not adequately reinforced, seemingly sturdy concrete structures toppled within seconds during the earthquake, or shortly after.

In Port-au-Prince, the most populated city in Haiti, the earthquake’s impact caused monumental damage and devastation. The Presidential Palace and the Port-au-Prince Cathedral collapsed. Government buildings crumbled to the ground, killing a quarter of the country’s civil servants. Hospitals and health care facilities fell. Hotels, schools, churches, jails, and houses went down in a matter of seconds. In and around the capital, roads were destroyed, and phone service went out, making it difficult for rescue workers to communicate with one another, as well as locate the injured, or those that were trapped under rubble.

Estimates put the number of dead in Haiti following the earthquake between 220,000 and 315,000. The number of injured is thought to be just as high. One and a half million people were displaced. Thirteen hundred camps were set up in the country, as 600,000 people left the capital to find refuge. Over 100,000 homes were completely destroyed, and nearly 200,000 were badly damaged. Nearly 19 million cubic meters of rubble filled the streets of Port-au-Prince after the earthquake. Those that lost their homes slept on the street, in parks or in cars, or were moved to tent camps set up by the government. Many of the displaced lived in camps for years after the earthquake, with little protection from weather or crime, and without proper sanitation and little access to clean water. The earthquake is estimated to have caused over $14 billion in destruction. In all, nearly 3.5 million people living in Haiti were affected, or one-third of the population.

*

It took two days and eight separate flights to get the entire medical team to the clinic after the earthquake. The team arrived one or two at a time. Garron was already scheduled to fly to Haiti that January. After his flight was rerouted, he ended up being one of the first volunteers to arrive to Jacmel. While they waited for the rest of the team to arrive, Dick and Boyer took Garron around town to see the scope of the destruction.

By the time Garron had landed in Haiti, over a week had passed since the earthquake hit. Aid organizations had already swarmed into Jacmel. The amount of aid was enormous, not only in terms of the number of relief workers, but in terms of supplies—food, water in plastic bottles and bags, tents, medications, and medical supplies flooded the town in an unorganized manner. Garron was taken aback by the chaos—as they walked through the center of Jacmel, where the aid organizations were stationed, there didn’t seem to be any coordination among groups. It was difficult to tell what teams had which supplies, and who was distributing them. It didn’t seem as though anyone really knew what was happening.

Garron was also seeing a number of people in town with injuries caused by the earthquake. He mainly saw crushed hands, arms, and legs from those who had been inside buildings that collapsed. He came to refer to the situation in the days right after the earthquake as “Civil War medicine”— people with crushed limbs who had lost hope in saving them began using hardware store saws to perform desperate amputations.

Within a few days of arriving, Garron began taking patients at the clinic to schedule surgeries for the upcoming weeks. As he would find out soon enough, performing surgery in the aftermath of the earthquake would be trying. One of the main issues was the aftershocks. Within nine hours of the earthquake, thirty-two aftershocks were recorded. And although the number decreased in the days following the earthquake, they continued for weeks.

Haitians were terrified of the aftershocks, which wasn’t surprising to Garron. So many of them had lost their homes, just like Nelson had, in the earthquake. Others had not only lost their house, but had watched their families perish within it. The surgery team was deeply frightened every time the hospital shook. Not only was Garron continuously interrupted during surgery because of the aftershocks themselves, but he also had to contend with everyone running out of the building whenever one occurred. Garron would then have to go outside and try to talk everyone into coming back inside so he could finish the surgery.

But Garron knew he was fortunate to be able to perform surgeries at all—without the FOTCOH surgery program, he would not have had proper equipment and surgical supplies, let alone a place to perform surgery. And because of that, he was able to do more than other surgeons who had come to Haiti after the earthquake without similar resources. One of the Haitian patients Garron was able to help was a young girl, around eight or nine years old, who had lost her entire family when their house collapsed. She survived, but with a badly crushed hand. Garron operated on the girl’s hand four times in two weeks, and he was able to not only save it, but preserve some mobility, although limited.

It had been such a sad time in Haiti for everyone, including Garron. He was happy he had been able to do something nice to help the little girl. He proudly displays a picture of her in his office at home.

*

As Garron performed surgeries at the hospital, the rest of the medical team remained at the clinic, busily seeing patients. On top of treating patients with injures from the earthquake, the volunteers were still seeing their regularly scheduled patients, making their workload much larger than normal.

Dick remembered the clinic running smoothly in the weeks after the quake, even within the heightened urgency of the situation. One such emergency involved a set of newborn twins who were brought to the clinic. Because their mother had high blood pressure, the twins had been born extremely premature, and they struggled to survive.

When the tiny babies arrived, the entire medical team worked together to try to save their lives. They improvised incubators out of Mylar and window frames and mixed up preemie formula for them. They took turns staying up all night to monitor the twins. Since the babies were too premature to feed with a bottle, they had to be fed using feeding tubes.

The next morning, the team knew they could no longer care for the twins—the clinic did not have the supplies or the personnel to continue the rigorous schedule of watching over them, and the team had hundreds of other patients waiting for treatment. The babies had also started to show signs of apnea, meaning they would require more sophisticated monitoring. The team urgently needed to get the twins to Port-au-Prince where other aid organizations would be more equipped to care for them. Fortunately, a medical volunteer on the team worked in emergency response at a hospital in the United States, and because of his connections, he was able to reach a Canadian team that agreed to take the twins to Port-au-Prince in an army helicopter. He and another team member traveled with the babies to the Toussaint Louverture International Airport where they delivered them to a great medical team from Israel, relieved knowing they were in good hands.

*

The team left Haiti after two weeks. Although they had done a lot of good work helping patients recover from injuries from the earthquake, it would be many years before Haiti itself would begin to recover. Clean up and construction in the country was slow. It often seemed as if Jacmel was being rebuilt one brick at a time. Sometimes it didn’t feel like any progress was being made. Dick never did see construction equipment in town removing the rubble, causing him, and many other people, to wonder where the aid money went and what was really being done to help Haiti rebuild.

After the earthquake, $13.5 billion was donated or pledged for relief efforts. But, despite the influx of money to support and rebuild in Haiti, less than half of one percent of the funds went to Haitian NGOs. Only one percent of funds went to the Haitian government. More than ninety percent of funding went to either international NGOs, private contractors, UN agencies, or never left the country in which it was donated. Relief aid mostly went to providing food, water, tarps, and tents in the months and years after the earthquake, which, while necessary for the short term, did not create lasting change for the Haitian people.

Dick felt like money was being wasted in the aftermath of the earthquake. It still bothers him to this day. To him it seemed like money was being spent frivolously. He saw relief workers driving around in huge, brand new vehicles, paying exorbitant rent for places to stay in Jacmel. He never saw Haitians hired to do any real work. They were hired to do simple jobs like sweeping up trash in the street or working as drivers. Sometimes they worked as interpreters. But Haitians were not hired to rebuild in their own country. The NGOs hired employees and contractors coming from the United States, France, and Canada, to name a few, and that money went back to those countries—it didn’t stay in Haiti. It just didn’t seem like the money was being spent on the Haitian people. It didn’t make sense to Dick. He didn’t see why Haitians weren’t hired to do the work, to build their own buildings.

And Dick wasn’t the only one who felt that way. When the NGOs started arriving in Jacmel after the earthquake, Boyer had been offered jobs, but he turned them all down. He knew they wouldn’t stay in Haiti long, and he didn’t want short-lived employment. And he was right. A few years after the earthquake, the NGOs started disappearing. Having only had a plan to work for a certain number of years in Haiti—maybe one, or two, or three—the larger NGOs left when that time was up, whether their projects were completed or not.

Boyer wanted something more sustainable in his life—something he could rely on. And even though those NGOs could have paid him more, he knew it wasn’t going to last, and he knew the work wouldn’t be as rewarding. Working for Dick was different. Dick owned land, and he hired Haitians, and the clinic was permanent. Dick believed that money spent should stay in Haiti as much as possible. That is what mattered to Boyer, and he knew that is what mattered to Haiti and its people. He knew he could trust that Dick and the medical teams would be there for the Haitians. They had been coming to Haiti long before the earthquake, and he knew he could depend on them being in Haiti long after.

*

For years after the earthquake, Dick would remember a man by the name of Gensel Augustine. Augustine had found a little boy, only a toddler, underneath the rubble of a fallen building in Jacmel, mostly unharmed. Augustine pulled the boy out from the debris and took him home. Soon after, he brought the boy to the clinic to see if he could get some food and clothing for the child, as well as have him examined by a doctor.

After telling the team the story of how he found the boy, Augustine explained he had not wished to keep him if his family was looking for him. He had tried to find his family—he even took the boy to the police station so they could announce the child’s description over the radio. But after a few weeks, no one had claimed him. The police determined the family must have vanished in the earthquake. Augustine already knew he wanted to take care of him, even before hearing this news, and he gladly adopted the boy as his son, a first child for Augustine and his wife. And because of how he came into Augustine’s life, he named the boy Godson.

My name is Shelley. I am currently living in Los Angeles, California. I work for various non-profit organizations so I can help people around the world which also allows me to visit some very incredible places.

I also love to travel for adventure and fun, both with friends and family and sometimes solo. I have been to forty-two countries as of 2018. Thank you for reading my stories. All of the writing, photography, and video is by me.